What is palliative care?
Palliative Care is a multidisciplinary approach of care in which patients are actively involved in the decision making process to improve the quality of their life during a serious illness. It is typically offered at the beginning of a significant or life-changing or life-limiting illness to stop or lessen suffering and to help people understand that they have choices about their care. Palliative care is available on an inpatient basis and can be provided as a the main goal of care or as a supporting option. It is usually organized by a team of doctors, nurses, and specialists who work together with the patient's primary care physician.
It is often difficult for families and patients to understand that decisions are not always cut and dry. Sometimes doing nothing is the best thing for a patient and sometimes full-court press is the best thing – your treatment depends on what your goals of care are and what you want at that stage of your life.
How does palliative care benefit patients?
Many people are not aware that a doctor has to tell you everything that could be done, but whether it should be done, that is a different question. Physicians have the ability to keep someone from dying, but they may not have the ability to restore them to health. In those cases, treatment may be prolonging how long it takes someone to die.
In palliative care, issues are discusses as how to deal with discomfort (physical and psychological distress), what to do with regard to employment, or how to discuss feelings with family members. Sometimes we talk about what their doctor have told them and their interpretation. These issues can cause a lot of stress, sometimes more than the physical illness itself. When you take care of some of those stressors and when a patient is physically comfortable, then they have enough energy to survive and live a little longer.
How is palliative care and hospice related?
Hospice is a narrow aspect of palliative care when someone might be at risk of not surviving a six-month time-frame. For example, a child born with cystic fibrosis is eligible for palliative care, but is not eligible for hospice.
Why is it important to have these discussions about what type of care you want before a serious medical event?
Talking about these things gives your family some idea about what your hopes and dreams and wishes are. It is one thing to make decisions for a child, it is quite another thing to have responsibility for another human being and hope that you are making the right decision. Having some ideas about what to do doesn't make it easier, but it doesn't leave your family wondering if they did the right thing.
How is someone referred for a palliative care consultation?
Consultations require a referral from a physician or somebody similarly licensed such as a nurse practitioner.
Why is palliative care important?
Most palliative care practices are not money generators for the hospital, but they are good will generators. They empower patients to be more responsible for their own care and making decisions about their care. Sometimes this type of care assists in not doing testing that isn't going to change the treatment, and sometimes it gets people to achieve their goal of going home and being comfortable. Even if somebody opts for no treatment, care can still be provided. A patient can be kept comfortable, they can be kept clean, they can be kept safe and their dignity can be maintained. Suffering can be mitigated for both families and patients, and those are important goals.
Michael LaPenta, MD
Hospice and Palliative Care team
Dr. LaPenta has a certificate of added qualifications in Hospice and Palliative Care through the American Board of Family Medicine, in addition to his board certification in Family Medicine. He has more than three decades of experience working in family practice and was formerly one of the medical directors of Hospice of the Chesapeake.